National Tall Man Lettering List

The Commission is responsible for the development and stewardship of the National Tall Man Lettering List (the List). The Commission developed the List to help clinicians reduce the risk of medicine selection errors for medicines with look-alike, sound-alike (LASA) medicine names.

The List compiles LASA medicine name pairs (generic and brand name pairs) that have been predicted to pose the greatest risks to patient safety.

The Commission has revised the National Tall Man Lettering List, initially published in 2011. The updated List reflects the changes to the Australian Register of Therapeutic Goods, international Tall Man lettering lists, International Harmonisation of Ingredient Names and reported adverse incidents or near misses from hospital networks across Australia.

The List shows LASA medicine names in pairs or groups. The medicines names have Tall Man lettering applied to them consistent with the national convention and should be used in the form provided.

Printed labels used for inpatient dispensing, shelving in pharmacies, and ward medicines cupboards

Drug libraries for smart pumps

Automated medicines storage and distribution systems.

What is Tall Man lettering?

Tall Man lettering is a typographic technique that uses selective capitalisation to help make similar-looking (LASA) medicine name pairs easier to differentiate. It uses a combination of lower- and upper-case letters to highlight the differences between look-alike medicine names, helping to make them more easily distinguishable.

The List compiles LASA medicine name pairs (generic and brand name pairs) that have been predicted to pose the greatest risks to patient safety. For example:

rifaMPICin and rifaXIMin

proGRAF and proZAC

Tall Man lettering reduces error by warning clinicians about the risk of confusing medicine names. It also helps clinicians select the right product in electronic systems or from shelves.

Details of the original methodology and development of the National Tall Man Lettering List in 2011 are available from the National Standard for the Application of Tall Man Lettering Project Report.

Evaluating the Effect of the Australian List of Tall Man Names assessed the effect of Tall Man lettering on the confusability of medicines names, and determined if Tall Man lettering increased the rate of error.

Tall Man lettering in Australia

Implementing Tall Man lettering in Australia is encouraged by some, but the lack of standards for its application has been a significant barrier.

The Commission developed the National Tall Man Lettering List to:

Prevent the proliferation of various lists of Tall Man names, which may lead to inconsistency in the application of the technique and result in confusion among clinicians, software vendors, regulators and the pharmaceutical industry

Ensure that the best available scientific evidence is used to support the development of Tall Man names

Provide credibility to the technique as a tool, which can be used to help reduce the risks associated with look-alike, sound-alike (LASA) medicine name pairs.

National Tall Man Lettering issues register

As part of the National Tall Man Lettering List stewardship, the Commission encourages frontline clinicians to report any adverse incidents or near-misses related to LASA medicine pairs. Issues notified to the Commission are logged in the National Tall Man Lettering Issues Register and are reviewed by the National Tall Man Lettering Expert Advisory Panel (the panel).

The panel is responsible for making recommendations on the medicine name pairs that need to be included in the National Tall Man Lettering List. The panel follows a systematic process to decide on the medicine name pairs that would most benefit from the application of Tall Man lettering.

A report containing information on the outcomes of the panel’s consideration of issues that were addressed in the National Tall Man Lettering List 2017 is available below:

This report also contains information about the rationale for the general revision of the National Tall Man Lettering List.

The Commission invites requests for changes to the National Tall Man Lettering List, which can be made to your state or territory representative on the Health Service Medication Expert Advisory Group. Requests should be accompanied by evidence of confusion, including other possible factors contributing to the risk of patient harm.

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The Therapeutic Goods Administration (TGA) considers there is a lack of adequate scientific evidence for it to be satisfied that the risks to patients associated with the use of single incision mini‐slings for the treatment of SUI outweigh their benefits. These products have been removed from the Australian Register of Therapeutic Goods (ARTG)

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

In the short-term there are similar success rates for retropublic and transobturator

A

Obturator tapes slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.

A

However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.

B

Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen

C

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

In the short‐term there are similar success rates for retropubic and transobturator mid urethral slings

A

Obturator tapes are slightly quicker, with less blood loss, bladder perforation and voiding dysfunction difficulties. Most of these differences were small and the complications are readily able to be managed.

A

However in the medium term (>5 years) the reoperation for recurrent SUI greater in obturator group and a small number developed groin pain (3-4%) that is difficult to treat.

B

Retropubic considered as the preferred procedure with transobturator reserved for those patients with a hostile abdomen

C

* Grades of Recommendation

This pathway is adapted from UroGynaecological Society of Australasia (UGSA) Surgical treatment of SUI pathway (2016)

Similar success rates compared to MUS with longer operating time and possibly higher voiding dysfunction; fascial sling has lower rates of chronic pelvic pain, no risk of erosion or extrusion, and higher rates of post‐operative morbidity